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Clinical Problem Solving: Radiology
May 18, 2009

Radiology Quiz Case 2

Author Affiliations
 

C. DOUGLASPHILLIPSMD

Arch Otolaryngol Head Neck Surg. 2009;135(5):516-519. doi:10.1001/archoto.2009.35-a

A 3-month-old girl presented with a history of stridor since birth. The patient's mother reported that her inspiratory stridor was more pronounced than her expiratory stridor, which worsened with agitation and eating. The patient also had associated mild subcostal retractions but no apnea or cyanosis.

Examination of the patient's neck revealed a vague “fullness” in the right lower neck area but no obvious mass. Fiberoptic laryngoscopy demonstrated poor abduction of the right vocal cord and a narrowed glottic inlet without substantial supraglottic collapse. A magnified high-kilovoltage tomogram of the airway showed tracheal narrowing on the lateral view. Magnetic resonance imaging of the neck and chest without contrast was performed, and a 3-mm coronal slice from the T2-weighted sequence is shown in Figure 1. Computed tomography of the neck and chest with contrast was also performed (Figure 2and Figure 3).

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